Nephrotoxicity from Cancer Immunotherapy

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Abstract
Since systemic i.v. immunotherapy with Corynebacterium parvum is an effective immunopotentiating and immunotherapeutic agent in animals, clinical studies of this agent were undertaken. Toxicities in man were noted, but most are treated symptomatically. Three patients with metastatic melanoma developed oliguria, edema, diffuse bilateral pulmonary infiltrates, azotemia, hypoalbuminemia and hypocomplementemia, while receiving intravenous C. parvum therapy. All had renal biopsies that showed proliferative glomerulonephritis with subendothelial basement membrane deposits. Immunofluorescence showed glomerular Ig[immunoglobulin]G, IgA, IgM and the C3 component of complement. A 4th patient was found in retrospective chart review of 87 patients registered on 2 C. parvum-containing protocols. The frequency of the complication in this group was 3/87. Renal failure resolved in all 4 patients spontaneously after cessation of C. parvum immunotherapy. Serial evaluation of renal function should be done in all patients on systemic adjuvant immunotherapy.